Showing papers on "corneal ulcer published in 1998"

Mooren's Ulcer

Abstract: Background: Mooren's ulcer is a rapidly progressive, painful, ulcerative keratitis which initially affects the peripheral cornea and may spread circumferentially and then centrally. Mooren's ulcer can only be diagnosed in the absence of an infectious or systemic cause and must be differentiated from other corneal abnormalities, such as Terrien's degeneration. Although the etiology remains unknown, recent research has proposed an underlying immune process and a possible association with the hepatitis C virus. The response to medical and surgical intervention is typically poor, and the visual outcome can be devastating. Case series: Three patients presented to our clinic with inferior peripheral corneal defects characteristic of Mooren's ulceration. The first patient, a 67-year-old white male, presented with an area of progressive peripheral thinning of the left inferior cornea 1 week after a preoperative skin cleanser was inadvertently splashed in both eyes. This occurred during a surgical procedure to remove a basal cell carcinoma. The second patient, a 56-year-old white male, was treated for a recurrent left inferior corneal ulcer with impending risk of perforation. The third patient was a 68-year-old white male referred for a painful left inferior peripheral ulcer, which rapidly progressed into a bilateral corneal melt disorder. All patients were diagnosed with Mooren's ulcerative keratitis after they underwent extensive medical and laboratory testing to rule out an infectious or systemic cause of their corneal melt. The first patient was treated with oral steroids, as well as doxycycline, to control his acne rosacea. The second patient responded to aggressive treatment with topical steroid therapy. This patient also tested positive for hepatitis C. The third patient rapidly developed a perforated left cornea and was treated with a penetrating keratoplasty after a patch graft had failed. Discussion: Mooren's ulcer is an idiopathic, painful, progressive ulceration of the peripheral cornea. These ulcers usually respond poorly to conventional therapy, as there is limited knowledge of the pathophysiology of the disease. Evidence of an autoimmune component advocates the use of steroids and immunosuppressive agents. With further research and understanding of Mooren's ulcer, better treatment options may be available in the future.

An immunohistochemical study of endothelin-1 in the human eye

Abstract: PURPOSE. Endothelin-1 (ET-1) is a potent vasoconstrictive and neural peptide that has been demonstrated to be present and functionally active and important in the eye. This study was undertaken to examine for the first time the cellular distribution of ET-1 in the whole human eye. METHODS. Twelve human eyes were examined by immunohistochemical staining of paraffin sections, using an anti-ET-1 primary antibody and an ABC-detection system. RESULTS. Endothelin-1-immunoreactivity (ET-1-IR) was detected primarily in the fibrovascular stroma of the iris, ciliary body and choroid, in the retinal blood vessels, the ciliary and optic nerves, and in the corneal and the non-pigmented ciliary epithelium. CONCLUSION. In the eye, ET-1-IR is present in fibrovascular, neural and epithelial structures. Changes in the distribution and concentration of ET-1 may be relevant to a variety of ocular diseases including diabetes mellitus, hypertension, sickle cell disease, optic neuritis, AION, papilledema, corneal ulcer, corneal...

Vitamin A deficiency and xerophthalmia in an autistic child.

Abstract: A5-YEAR-OLD boy with severe autism was referred to the corneal and external disease service with a history of bilateral corneal ulceration. The referring ophthalmologist had examined the child under anesthesia and noted an active corneal ulcer in the right eye and a healed ulcer in the left eye. The patient’s mother stated that his eyes had appeared red and that he was light sensitive for several weeks, rubbing both eyes frequently during this time. She also noted that the child appeared to be clumsy, bumping into and falling over furniture inside the

A clinical algorithm for the management of facial nerve palsy from an oculoplastic perspective.

Abstract: Background/Aims Facial nerve palsy can be a sight-threatening complication. We have developed a flow diagram to aid in the management of these patients so that corneal complications may be avoided. This involves the recognition of a facial palsy and institution of treatment as guided by the flow chart. Method Fifty-six patients suffered a facial nerve palsy following acoustic neuroma surgery. All received regular topical ocular lubrication, followed by either botulinum toxin A (BTXA)-induced ptosis (if corneal exposure developed despite conservative treatment) or definitive eyelid surgery. Results Twenty-one patients required regular lubrication only. Of these patients treated for corneal exposure, 20 received BTXA with good resulting corneal cover. Unfortunately, 9 of these suffered diplopia, although in 4 this resolved quickly. Twenty-four patients underwent a total of 64 eyelid procedures including levator recession, lateral tarsorraphy, lateral canthal sling, medial canthoplasty and gold weight insertion. All patients had good corneal cover post-operatively and were cosmetically improved. Of the 56 patients with a facial nerve palsy, 7 presented with a corneal epithelial defect or an infected corneal ulcer. These all responded to treatment with BTXA, topical antibiotics and/or lubrication, and eyelid surgery. Conclusions Post-operative facial palsy may result in a significant ophthalmic workload. Although a proportion of patients with a facial nerve palsy manage well with regular lubrication, additional help with eyelid closure, either in the way of BTXA-induced ptosis in the short term or definitive eyelid surgery in the long term, is often required. Eyelid surgery seems to be the mainstay of treatment, for both function and cosmesis, with many patients requiring a combination of procedures.

Current diagnosis and treatment of corneal ulcers.

Abstract: Successful treatment for a corneal ulcer requires proper diagnosis and antibiotic selection. The management should be guided by the severity of the clinical presentation, the ophthalmologist's confidence in making the proper diagnosis of bacterial keratitis, and the level of trust in the antibiotic agents chosen for the causative organisms. Universal standards include pretreatment cultures and dual broad-spectrum fortified antibiotics. Recent changes in practice suggest that empirical monotherapy treatment with a fluoroquinolone antibiotic may be appropriate for certain cases of bacterial keratitis. This article reviews the various diagnostic methods and treatment options currently practiced in the ophthalmic community.

Topical use of zinc desferrioxamine for corneal alkali injury in a rabbit model.

Abstract: PURPOSE To evaluate the efficacy of topical zinc desferrioxamine in acute corneal alkali injury in rabbits. METHODS Twenty rabbits were anesthetized and a standardized alkali burn (1N NaOH) was performed in the center of the cornea (7.5-mm diameter). The animals were randomly divided into two groups and treated (double-masked) with topical zinc desferrioxamine, 220 microM, (group 1) or its vehicle (group 2). Drops were applied 7 times/day for 28 days. Topical gentamicin, 0.3%, was instilled twice a day. Animals were evaluated twice a week. At each examination (using the slit-lamp), the depth of corneal ulcer was graded as follows: 0, no ulcer; 1, tissue loss less than one third of corneal thickness; 2, one third to two thirds tissue loss; 3, more than two thirds tissue loss; 4, descemetocele; or 5, perforation. Ulceration area, vascularization, and epithelial defects also were measured. RESULTS During the study period, the grading of mean corneal ulcerations in group 1 ranged from 0.2 to 1.00, whereas in group 2, it ranged from 1.4 to 2.7. The mean grade and area of ulceration in group 2 were greater than those in group 1 (p < 0.05). CONCLUSION Topical zinc desferrioxamine may be an adjunctive treatment in protecting the cornea against induced alkali injury.

Corneal Ulcer Caused by Nocardia asteroides in a Patient with Leprosy

Abstract: Nocardia asteroides is a rare cause of keratitis usually associated with trauma. We report a case of corneal ulceration caused by N. asteroides in a patient with leprosy. This is the first case report of nocardial keratitis from Southeast Asia. The diminished corneal sensation in a patient with leprosy could be a predisposing factor for development or exacerbation of corneal ulceration.

A review of ocular emergencies in a Taiwanese medical center

Abstract: BACKGROUND Ocular injury is one of the most common problems in the Emergency Department (ED), but a general survey of ocular injuries has rarely been reported in the literature. This article reviews cases of ocular injury collected in the ED of a medical center over a 12-month period. METHODS A retrospective analysis was done on 1,314 consecutive patients who presented with eye complaints to the ED of the Veterans General Hospital-Taipei between November 1993 and October 1994. Common ocular diagnoses and their associated variables were assessed separately. RESULTS Ocular injuries occurred in a male to female ratio of about 1.9:1 with a peak age in the third decade. Diagnoses were grouped as trauma (43.8%) and non-trauma (56.2%). Corneal abrasion was the most common trauma reported. The main circumstances of eye trauma were play (50.0%) in children (< 15 years), work (37.1%) in the age group of 16 to 59 years and domestic activity (45.8%) in patients over 60 years of age. Blunt objects and contusions (hits or falls) caused nearly 50% of all ocular injury cases. Most of the non-traumatic cases were due to acute conjunctivitis (19.1%), followed by contact lens (CL)-related disorders (11.4%). Three cases of CL-induced corneal ulcer resulted in permanent visual morbidity. There was a trend toward an increase in acute conjunctivitis in the summer, corneal ulcer in the spring and acute glaucoma in the winter. CONCLUSIONS Young males were found to run a higher risk of ocular accidents, especially at work. Penetrating injuries with or without a retained intraocular foreign body were the leading cause of poor visual outcomes and often occurred in patients without protective eyeglasses. With the widespread use of CLs, many potentially serious complications were noted in the ED, which deserve attention.

Corneal ulcers from contact lenses during travel to remote areas.

Abstract: To the Editor: Travelers to remote destinations may not have access to immediate medical care in case of an emergency. Contact-lens wearers, in particular, should take precautions, since they are s...

Phacoemulsification and posterior chamber intraocular lens implantation after scleral buckling, vitrectomy, or both.

Abstract: BACKGROUND AND OBJECTIVE: Previous studies have documented the risk of complications for eyes with prior vitreoretinal surgery that later undergo intracapsular or extracapsular cataract extraction. The authors reviewed the records of patients with a history of vitreoretinal surgery and subsequent phacoemulsification to assess the visual outcome in the relatively early postoperative period and to determine the risk of postoperative complications. PATIENTS AND METHODS: The authors identified 21 eyes of 21 patients with a history of scleral buckling, vitrectomy, or both, who subsequently underwent phacoemulsification. Data recorded before, during, and after surgery were reviewed. RESULTS: The best-corrected visual acuity improved in 20 (95%) of 21 eyes, and the final best-corrected visual acuity was 20/40 or better in 12 (57%) of 21 eyes. The intraoperative complications included iridodialysis, zonular dialysis, and posterior capsular rupture. The immediate postoperative complications were microcorneal edema, anterior chamber hyphema, vitreous hemorrhage, and fibrinous pupillary membrane. No retinal detachments occurred during the postoperative follow-up period, which ranged from 3 to 10 months. Late complications included isolated cases of posterior capsular opacity, herpetic corneal ulcer, and iris posterior synechia; however, the final visual acuities were not limited, except in one eye with a corneal ulcer. CONCLUSION: Although some postoperative complications did occur, they did not limit final vision, and useful vision was achieved.

Topical pefloxacin in bacterial keratitis.

Abstract: Problem: To evaluate the clinical efficacy and safety of topical pefloxacin 0.3% drops as the sole antibiotic used to treat culture positive bacterial corneal ulcers. Methods: Forty two consecutive Gram's smear-positive cases of bacterial corneal ulcers were enrolled for this prospective open labelled clinical trial. All patients underwent a complete clinical and microbiological work up and were put on topical 0.3% pefloxacin drops with supportive cycloplegic, vitamins and antiglaucoma therapy. Of 42 cases, 4 cases of mycotic keratitis and 6 culture negative cases were excluded from the study. Results: Positive microbiologic cultures were obtained in 84.2% (32 of 38) cases. Staphylococcus aureus (14/32; 43.7%) and coagulase negative Staphylococci (12/32; 37.5%) were the two most common organisms isolated. Resolution of the corneal ulcer was achieved in 31 out of 32 cases (96.9%) with a mean duration of 9.3 ± 5.3 days (range 3–21 days). Best corrected visual acuity of 20/200 or better was achieved in 65.6% of cases at 4 weeks post resolution. Corneal deposits were observed in one case which disappeared 8 days following discontinuation of therapy. Conclusions: Topical pefloxacin is effective as a single antibiotic agent for the treatment of bacterial keratitis.

Cas d'un ulcère à Exophiala dermatitidis

Abstract: The authors present one case of corneal Exophiala dermatitidis ulceration. This case is analyzed in the field of corneal mycosis infection. Classification, rate, clinical history, biomicroscopy aspects will be discussed. Technical samples will be described. Anatomopathologic slides will be discussed. Finally the medical or surgical treatment will be considered.

Anterior segment complications of indirect diode laser in diabetic patients

Abstract: Editor,—We describe two cases of recurrent corneal epithelial breakdown following indirect diode laser panretinal photocoagulation (PRP) in diabetic patients. The particular nature of diode laser burns may have contributed to this event. ### CASE 1 A 21 year old insulin dependent diabetic woman underwent bilateral indirect diode laser PRP under general anaesthesia for proliferative diabetic retinopathy (PDR). She presented 4 weeks later with a 3 week history of a painful left eye. Visual acuity was 6/12 and a 3 mm × 2 mm infiltrative corneal ulcer was noted. There was total corneal anaesthesia bilaterally and both pupils were mid dilated and non-reactive to light and accommodation. Microbiology was negative and the ulcer gradually healed with intensive topical antibiotic treatment. Over the next 3 months corneal anaesthesia persisted in the left eye, but resolved in the right. She had two further episodes of corneal epithelial breakdown on the left which were successfully managed with topical lubricants. One year after laser treatment visual acuity was 6/6 in the right eye and 6/12 in the left, with residual stromal scarring on the left (Fig 1). Both pupils remained mid dilated and non-reactive. …

[Corneal ulcerative lesions in type-I immediate hypersensitivity].

Abstract: The vernal keratoconjunctivitis (KCV) is included within the category of the hypersensitiveness diseases, the immunopathological mechanism which causes the disease being represented by a type-I hypersensibility reaction. The mechanism which determines the appearance of the corneal lesions isn't entirely cleared up, but there are however some pathogenic links which have been already deciphered. The type I hypersensibility reaction is taking place within two stages: stage I the stage of the sensitizing contact and stage II the stage of the unleashing contact. During the first stage, the Langerhans cells take over and process the allergen, exhibiting on their surface only the antigenic part. The Langerhans cells interact with the T helper native cells (Tho), cells from which there will result the predominantly differentiated Th2 subtype. The Thz cells will activate, by means of the interleukines, the B cells (which produce the IgE), the mast cells and the eosinophilic cells. During the second stage, the allergen is coming into contact with the IgE specific antibodies, which are fastened on the mast cells membrane, generating the opening of their granules. The result of this evolution is represented by the unleash of vasoactive mediators, own enzymes, chemical mediators (among which there is also the eosinophilic chemotactic factor ECFA). The latter contributes to the infiltration of the epithelial and of the subepithelial tissue with eosinophilic cells. The major basic protein (PBM), one of the proteins released from the eosinophilic cells' big granules, plays a major pathogenic role in the production of the corneal ulcer, by means of its direct cytotoxic effect and also by means of inhibiting the migration of the epithelial corneal cells. The role of the mast cells and also the role of the neutrophile cells within the framework of the pathogenesis of the ulcer is disputable, because some specific enzymes tryptase, respectively elastase--have been found within the debris of the corneal ulcer. The allergic keratoconjunctivitis (KCA) represents the ocular manifestation of the systemic hypersensitiveness. In the beginning the immunopathogenic mechanism which causes the lesions is represented by a type-I hypersensibility reaction, but during its evolution, the characteristic histopathological changes (chronic granulomas, perivascularitis, subendothelial fibrosis) are suggesting a complex immunoregulatory disfunction.

Micosis ocular postraumática por Penicillium oxalicum

Abstract: An ocular fungal infection in a 33 year-old man is reported. The patient had a traumatic corneal ulcer with subsequent abscess and perforation. Antibiotics were administered at the beginning of the treatment. Two successive conjunctival flaps were performed but were unsuccessful, followed by a corneal transplant with unfavorable outcome and the appearance of endophthalmitis. Material from the vitreous and corneal ulcer margins was obtained and Penicillium oxalicum Currie & Thom was isolated in the Mycology laboratory. Local and systemic antifungal therapy was unsuccessful and the eyeball was enucleated.